A 71-year-old female has a history of peripheral vascular disease, coronary artery disease, hypertension and hyperlipidemia. This patient has undergone numerous cardiac and peripheral procedures in the past. On a previous occasion, an 8 x 40 Smart Stent was placed in the right external iliac artery, and a 7 x 40 Smart Stent was placed in the proximal right superficial femoral artery.

Acquisition protocol

• Scanner: GE Healthcare LightSpeed® VCT
• Scan type: CT abdomen/aorta with peripheral runoff
• Helical
• kVp: 120
• mA: 170
• Noise index: 12.0
• Rotation speed: 0.60 second
• mAs: 102
• Slice thickness: 1.25 mm
• Collimation: 40 mm (64 x 0.625 mm)
• Pitch: 0.984:1
• SFOV: 50 cm

Clinical findings

The CTA exam images helped the radiologist determine the following: Moderate to possibly greater in-stent restenosis of the right external iliac and right superficial femoral artery stents. Severe focal stenosis in the right common femoral artery. Moderate stenosis of the distal superficial femoral artery on the right. Probable occlusion of the left superficial femoral artery with multiple collateral vessels. Focal aneurysm of the proximal left superficial femoral artery measuring 2.4 x 2.6 cm in diameter and 4.1 cm in length.

Significant disease of the superficial femoral artery on the left. Collateral flow is provided by the profunda femoris artery and muscular collaterals to the level of the distal superficial femoral artery. There is a second aneurysm of the left superficial femoral artery measuring 4.1 cm in length by 2.1 x 2.2 cm in diameter. This appears to be predominately thrombosed. Distal to this there is adequate three-vessel runoff to the left ankle. There is a mild stenosis at the origin of the anterior tibial artery.

• The improved acquisition speed and temporal resolution of the LightSpeed VCT system using VesselIQ Xpress has improved our capabilities for imaging the peripheral vascular system over our single-slice, 4-slice and 16-slice systems.
• The depiction of the plaque accumulation within the two stents depicted in this case is, in my opinion, outstanding and was very useful in making a complete and accurate diagnosis in this case.
• The new VesselIQ Xpress software was of great help in assessing this case. The ability to use curved planar reformations to evaluate the vessel lumen is a significant advance over earlier versions of the software. As we know from using curved planar reformations to evaluate the coronary arteries, we are now able to view the entire vessel lumen and wall in 360 degrees of rotation for each vessel. This enabled us to determine the presence, shape, and degree of luminal encroachment of even small plaques. As demonstrated here, we now have a powerful tool for assessing intravascular stents. In addition, when trying to make a diagnosis within the small infrapopliteal arteries, VesselIQ Xpress truly shines, decreasing the time a physician must spend to make a diagnosis as well as substantially improving the physician’s degree of confidence in that diagnosis.